Clinic for Urological Reconstruction

BLADDER CANCER

(BC) is an age-associated malignancy with increased prevalence in the elderly population
Development of systemic therapies with increased efficacy against BC and reduced toxicity are practiced here, as are techniques and interventions like surgery and radiation for patients with BC.
Many older patients with BC have comorbid conditions and impairments of activities of daily living, which we are there to explain all by making therapeutic recommendations.

Diagnosis

To find or rule out bladder cancer, you may get several tests, including a CT scan, MRI scan or ultrasound and urine tests to look for abnormal cells that could be cancerous.
A more definitive test is a procedure called a cystoscopy, in which your doctor looks inside the bladder using a thin lighted tube passed through the urethra. The next step would be a biopsy and removal of the visible tumor, which is then examined in a lab. With that information, you and your medical team can start planning your treatment.
Management of muscle invasive bladder cancer in the elderly :

Transurethral resection of Bladder Tumor (TUR) with fulguration

During TUR with fulguration, the doctor inserts a cystoscope (a thin lighted tube) into the bladder through the urethra. A tool with a small wire loop on the end is then used to remove the cancer or to burn the tumor away with high-energy electricity. This is known as fulguration.

Radical cystectomy

A radical cystectomy is an operation to remove the entire bladder and the surrounding lymph nodes. In men, radical cystectomy typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy may involve removal of the uterus, ovaries and part of the va**na.
Radical cystectomy can be performed through an incision on the lower portion of the belly or with multiple small incisions using robotic surgery. During robotic surgery, the surgeon sits at a nearby console and uses hand controls to precisely move robotic surgical instruments.

• Neobladder reconstruction.
After a radical cystectomy, your surgeon must create a new way for urine to leave your body (urinary diversion). One option for urinary diversion is neobladder reconstruction. Your surgeon creates a sphere-shaped reservoir out of a piece of your intestine. This reservoir, often called a neobladder, sits inside your body and is attached to your urethra. The neobladder allows most people to urinate normally. A small number of people difficulty emptying the neobladder and may need to use a catheter periodically to drain all the urine from the neobladder.

• Ileal conduit.
For this type of urinary diversion, your surgeon creates a tube (ileal conduit) using a piece of your intestine. The tube runs from your ureters, which drain your kidneys, to the outside of your body, where urine empties into a pouch (urostomy bag) you wear on your abdomen.

Chemotherapy: neoadjuvant and adjuvant

Chemotherapy improves overall survival for patients . Its the most active cytotoxic agent against BC. Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given alone or with other types of treatment. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation therapy

Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Bladder cancer is sometimes treated with external beam radiation therapy. This type of radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. Radiation therapy may be given alone or with other types of treatment, such as chemotherapy.

Intravesical chemotherapy

For bladder cancer, chemotherapy may be intravesical, meaning it is put into the bladder through a tube inserted into the urethra. Intravesical treatments flush the bladder with drugs that kill cancer cells that remain after surgery. This lowers the chance of the cancer coming back.

Immunotherapy

Immunotherapy helps a person’s immune system fight cancer.
Intravesical immunotherapy
BCG (bacillus Calmette-Guérin) is an intravesical immunotherapy drug used to treat bladder cancer. BCG is given in a solution that is placed directly into the bladder using a catheter (thin tube). Intravesical treatments flush the bladder with drugs that kill cancer cells that remain after surgery. This lowers the chance of the cancer coming back.

Targeted therapy

Targeted therapy uses drugs or other substances to block the action of specific enzymes, proteins, or other molecules involved in the growth and spread of cancer cells.

Clinical trials

A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer.

Follow-up testing

Some of the tests that were done to diagnose or stage the cancer may be repeated. Some tests will be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. These tests are sometimes called follow-up tests or check-ups.

PLEASE prepare yourself if you have any signs or symptoms that worry you, such as blood in your urine or issues mentioned in our below post to meet by taking appointment to our Uro Onco Surgeon Dr.Gopalakrishnan for your treatment .
for Urological Reconstruction

: 4 Warning Signs That Could Mean Bladder Cancer :

Here are four possible warning signs you should never ignore:

1. Invisible blood in your urine
The urine sample you leave as part of a routine checkup or other medical visit is often checked for microscopic amounts of blood during a lab test called urinalysis. If even a few red blood cells are found, you should always report to your urologist.Other possible causes include urinary tract infections, kidney or bladder stones and prostate problems. Women with blood in their urine often are assumed to have urinary tract infections, but that diagnosis should always be confirmed with a culture, a test that finds any bacteria growing in the urine.

2. Visible blood in your urine
The first sign of bladder cancer may be blood you see in your urine stream or in the toilet bowl. Usually, it’s pink or red and isn’t accompanied by any pain. Even visible blood usually has an explanation other than cancer. Certainly to contact your Urologist.

3. Problems with urination
While less common than blood in the urine, changes in urination patterns also can be early signs of bladder cancer. Those changes can include having to p*e more often, waking up multiple times to p*e at night, feeling like you have to p*e even when you don’t or having a weak urine stream. If some of those symptoms sound familiar to many older people, it’s because they are common signs of other problems that become more frequent with age.Just because things are common doesn’t mean they are normal. Such changes rarely signal cancer. The most common causes include infections, overactive bladder and, in men, prostate enlargement.

4. Pain
Most people with early bladder cancer feel no pain. But sometimes, the cancer can cause painful urination or flank pain, between the abdomen and lower back on one side. Painful urination is more likely to be due to an infection, and flank pain can have many different causes, from infection to arthritis to gallbladder disease. But such symptoms should always be checked out.Some people with bladder cancer don’t notice symptoms until their cancer is more advanced.
What happens next?
If your symptoms don’t have other good explanations, please visit to us.You should expect your doctor to ask not only about your symptoms, but also about your medical and personal history. The workup you get may depend partly on how high your bladder cancer risk is.
Older adults and current or former smokers are at much higher risk than younger people or never-smokers. People exposed to certain cancer-causing chemicals in their work also have a heightened risk, They include people who have worked in the making of dyes, rubber, leather, textiles and paint. Hairdressers, who are exposed to dyes, and truck drivers, exposed to diesel fumes, also have a higher-than-usual risk.

(If you are wondering how cigarette smoke and other toxins cause bladder cancer, the answer is exposure plus time: Your body concentrates toxins in urine, which then sits in your bladder long enough to cause harm.)

on reading more on our next post for details...

Common Urinary Problems in the Elderly which should not be Ignored

As people age, the urinary system undergoes significant changes, leading to various urinary problems that can significantly impact one’s quality of life. Common issues among the elderly include urinary incontinence, infections, bladder stones, overactive bladder, and prostate problems in men. These conditions not only pose medical challenges but also affect one's social and emotional well-being. Understanding these urinary problems is crucial for effective management and care. Dr.Gopalakrishna highlights the types of urinary problems in the elderly, risk factors, and available treatment options:
Common Urinary Problems in the Elderly
Urinary Incontinence
This is the loss of bladder control, leading to the involuntary leakage of urine. Incontinence can be categorized into several types:

Stress Incontinence: Stress incontinence is the most common form of incontinence. It means you leak urine with actions such as coughing, laughing, sneezing, or exercising. It happens when the pelvic floor muscles that support the bladder are weakened. Childbirth is a common reason for a weak pelvic floor.
Urge Incontinence: In urge incontinence, urine leaks before you get to the toilet when you have urgency. Urgency and urge incontinence is often due to an unstable or overactive bladder or detrusor instability. Bladder training exercises are the first line of treatment.
Overflow Incontinence: Occurs when the bladder doesn't empty, leading to dribbling. This condition is marked by a persistent feeling of incomplete voiding and can be associated with factors such as an obstruction in the urinary tract or nerve damage. Addressing the underlying cause is crucial in managing overflow incontinence.
Functional Incontinence: Due to physical or mental impairments that prevent one from reaching the toilet in time. This form of incontinence is not directly related to bladder dysfunction but rather to challenges in mobility, cognition, or communication. Treatment may involve addressing the underlying impairments and implementing strategies to enhance accessibility to bathroom facilities.
Urinary Tract Infections (UTIs)
The elderly are prone to urinary tract infections, which can cause discomfort and complications if left untreated. Factors such as weakened immune systems and urinary retention contribute to their susceptibility. Recognizing symptoms like frequent urination, pain, or cloudy urine is crucial. UTIs require prompt medical attention, typically involving antibiotic therapy.
p:s (prioritizing on male UTI's)

Bladder Stones
The formation of mineral deposits in the bladder can result in bladder stones, a condition more common in the elderly. These stones can lead to pain, changes in urine colour, and increased frequency of urination. Treatment options include medication, increased fluid intake, or, in severe cases, surgical procedures to remove the stones.

Overactive Bladder
An overactive bladder is characterised by a sudden, intense urge to urinate, often leading to incontinence. Ageing contributes to a loss of bladder elasticity and control. Behavioural therapies, medications, and lifestyle modifications are employed in managing overactive bladder symptoms, providing relief, and enhancing the overall quality of life for affected individuals.

Prostate Problems in Men
Men in their later years commonly face prostate problems, such as benign prostatic hyperplasia (BPH) or prostate cancer. These conditions can obstruct the urinary flow, causing difficulties in starting or stopping urination. Treatment options range from medications to surgical interventions depending on the severity and nature of the prostate issue.

Risk Factors
Here are key factors and preventive measures:

Reduced Mobility: Limited physical activity can lead to weaker bladder muscles and reduced bladder capacity.
Chronic Health Conditions: Diabetes, stroke, and neurological diseases can interfere with bladder function.
Medications: Certain medications may exacerbate urinary incontinence or retention.
Hormonal Changes: Post-menopausal hormonal changes in women can affect bladder control.
Lifestyle Factors: Obesity, smoking, and excessive alcohol consumption can increase the risk of urinary problems.

Diagnosis
Dr. Gopalakrishna recommends a few tests to treat urinary problems:

Re**al Examination
Re**al examination (palpation of the prostate through the re**um) may reveal a markedly enlarged prostate, usually affecting the middle lobe. The expert may recommend a few blood tests to rule out prostate cancer.

Serum PSA
A high Prostate Specific Antigen (PSA) level is a marker of prostate cancer, however, certain tests like PSA density, PSA free %, and re**al examination are required to confirm the diagnosis.

Blood Sugar
Blood sugar is tested to rule out the possibility of Diabetes Mellitus

Ultrasound KUB
Ultrasound KUB is done to know the prostate size, status of the kidney, residual urine volume, and any other urinary stone problems.

REPORT TO US THEN

Treatment
The treatments for urine problems in old age include:

To alleviate nighttime symptoms, it's advisable to minimise fluid intake, especially after 4 p.m. However, ensure a daily fluid intake of no less than 1.5 litres. Steer clear of alcohol, caffeinated beverages (such as tea and coffee), and smoking.
To enhance bladder control, consider bladder training. Gradually increase the time between toilet visits and aim to pass more urine each time. This technique aids in expanding the bladder muscle's capacity.
Engage in pelvic floor exercises to prolong urine retention. These exercises contribute to better bladder control over time.
Explore medicinal options in here to address symptoms related to benign prostatic hyperplasia (BPH), overactive bladder, and storage issues. In cases where medical interventions prove insufficient, surgical management may become necessary.

Addressing urinary problems in the elderly is pivotal to enhancing their quality of life. Effective management, and embracing medical interventions and lifestyle changes, are key to improving these conditions. At Clinic for Urological Reconstruction, a leading urology centre in the hands of Dr.Gopalakrishna, we specialise in offering comprehensive and compassionate care for elderly patients facing urinary issues. Dr. Gopalakrishna alongwith his expert team, including renowned team associate urologists, and advanced facilities are dedicated to providing personalised treatment plans that prioritise the comfort and well-being of each patient. Reach out to us for the best services in providing solutions for urine problems in old age, ensuring comprehensive care, and effective treatment plans.

Fortis Hospital & Kidney Institute, Kolkata, achieved a milestone with the Holmium Laser Enucleation of the Prostate (HOLEP). The surgery was conducted on a 74 year old patient having a Huge Prostate Enlargement.
Dr R.K. Gopala Krishna and his team helped the patient experienced a remarkable restoration of urinary function thereby ending nearly a decade of struggle.

Advancing in surgical excellence with state-of-the-art technology, Fortis proudly introduces the Fortis Institute of Robotic Surgery at Anandapur, Kolkata. A testament to our commitment to pioneering healthcare through cutting-edge innovations.
Clinic for Urological Reconstruction.Dr.Gopalakrishna

Centre for comprehensive Uro-onco Care
Presented by Dr.Gopalakrishna

An update in Fit Tak basis the video shared by Dr Raj Kalyan Gopala Krishna, Director- Urology/ Andrology Uro-oncology,Kolkata Fortis Hospital & Kidney Institute, Rash Behari on 'What is BPH - its symptoms, causes & treatment option.
https://www.youtube.com/watch?v=46p4PNKNrLY

What is BPH? | Benign Prostatic Hyperplasia | Prostate Enlargement In this video you will learn what is BPH? How does it affect. What are the causes and symptoms? And what are the treatment options available? You can follow ...

Health Awareness Programme in Advances of Urology sphere held in SBI ,Bidhannagar Zonal Office.

https://youtu.be/NDYkYw8RCU0
First Laparoscoopic Urinary Bladder and Ureter Reconstruction conducted at
.Gopalakrishna
Press Meet

For more Information Call us on: +91 70036 04192

Indias First Laparoscoopic Urinary Bladder and Ureter Reconstruction by Dr.Gopalakrishna First Laparoscoopic Urinary Bladder and Ureter Reconstruction conducted at .GopalakrishnaPress Meet ...

Press Meet First Laparoscoopic Urinary Bladder and Ureter Reconstruction conducted at
.Gopalakrishna

For more Information Call us on: +91 70036 04192
://www.youtube.com/channel/UCRrfJ2eTAuqZ_tTUXRIS7cA

Seminar on Recent Advances in Laparoscopy of Urology in Bank Of India,Kolkata ,Samriddhi Bhawan
Sponsored by Kidney Institute

A case of 70 yr old man of anatrophic nephrolithotomy - Its a procedure in which a parenchymal incision is made in an intersegmental plane, allowing removal of large renal calculi or multi calculi like this.
Dr. Gopalakrishna

Dr. R.K Gopalakrishna assenting the acknowledgement of the stance as Secretary of prestigious BENGAL UROLOGICAL SOCIETY at HHI Kolkata.
Dated : 18.09.2021

Clinic For Urological Reconstruction, Kolkata
Dr. R .K Gopalakrishna performs a Right Transperitoneal Laparoscopic Pyeloplasty
Learn more on :
https://www.youtube.com/channel/UCRrfJ2eTAuqZ_tTUXRIS7cA

OVERVIEW :
20 year boy with right PUJ obstruction

Plan : Plan Laparoscopic Right Transperitoneal Pyeloplasty

For more information :
Like,subscribe,comment please
Call-7003604192 (For any queries or Appointment)
[email protected]
website-www.gopalakrishna.in
Find us on Facebook
Clinic for Urological Reconstruction, Kolkata
https://youtu.be/AoQeddZRSs4

Laparoscopic Transperitoneal Right Pyeloplasty | C Ure, Kolkata | Dr.R.K GOPALAKRISHNA | Clinic For Urological Reconstruction, KolkataDr. R .K Gopalakrishna performs a Right Transperitoneal Laparoscopic Pyeloplasty Learn more on :https://www.you...

Clinic For Urological Reconstruction, Kolkata
Dr. R .K Gopalakrishna performs a Laparoscopic Pyeloplasty For Retro Caval Ureter.
Learn more on :
https://www.youtube.com/channel/UCRrfJ2eTAuqZ_tTUXRIS7cA

OVERVIEW :
20 year girl with right loin pain
CT Urogram shows obstruction due to
retro caval ureter.

Plan : Plan Laparoscopic Pyeloplasty

For more information
Like,subscribe,comment
Call-7003604192 (For any queries or Appointment)
[email protected]
website-www.gopalakrishna.in
Find us on Facebook
Clinic for Urological reconstruction,Kolkata
https://youtu.be/M4lMsornOH4

Laparoscopic Pyeloplasty For Retro Caval Ureter | C Ure, Kolkata | Dr.R.K GOPALAKRISHNA | Clinic For Urological Reconstruction, KolkataDr. R .K Gopalakrishna performs a Laparoscopic Pyeloplasty For Retro Caval Ureter.Learn more on :https://www.you...

Laparoscopic
Left renal pedicle control at the root of mesentery
DR R.K GOPALAKRISHNA
For more information:
Like,Comment & Subscribe
Website-www.gopalakrishna.in
[email protected]
Call-7003604192,9051117171
https://youtu.be/adkF-DZzN6Y

www.gopalakrishna.in